Neck strap, crown strap assembly and headgear for a breathing mask

ABSTRACT

A neck strap, a crown strap assembly and a headgear for a breathing mask. The neck strap for a headgear includes a one-piece main body adapted to engage a patient&#39;s neck, first and second lower connection portions adapted to connect to first and second lower mask connection straps, and first and second upper connection portions adapted to connect to respective first and second lateral crown straps.

1 CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.17/524,859, filed Nov. 12, 2021, which is a continuation of U.S.application Ser. No. 16/299,269, filed Mar. 12, 2019, now U.S. Pat. No.11,179,536, which is a continuation of U.S. application Ser. No.14/783,941, filed Oct. 12, 2015, now U.S. Pat. No. 10,335,568, which isthe U.S. national phase of International Application No.PCT/AU2014/000379, filed Apr. 9, 2014, which designated the U.S. andclaims priority from European Application No. EP 13163546.8, filed Apr.12, 2013, the entire contents of each of which are incorporated hereinby reference in their entirety.

A portion of the disclosure of this patent document contains materialwhich is subject to copyright protection. The copyright owner has noobjection to the facsimile reproduction by anyone of the patent documentor the patent disclosure, as it appears in the Patent and TrademarkOffice patent file or records, but otherwise reserves all copyrightrights whatsoever.

2 BACKGROUND OF THE TECHNOLOGY 2.1 Field of the Technology

The present technology relates to one or more of the detection,diagnosis, treatment, prevention and amelioration of respiratory-relateddisorders. In particular, the present technology relates to medicaldevices or apparatus, and their use.

More particularly, the present technology relates to a neck strap, acrown strap assembly and a headgear, e.g., for a patient interface,e.g., breathing mask, for instance used in a Positive Airway Pressure(PAP) therapy.

2.2 Description of the Related Art 2.2.1 Human Respiratory System andits Disorders

The respiratory system of the body facilitates gas exchange. The noseand mouth form the entrance to the airways of a patient.

The airways include a series of branching tubes, which become narrower,shorter and more numerous as they penetrate deeper into the lung. Theprime function of the lung is gas exchange, allowing oxygen to move fromthe air into the venous blood and carbon dioxide to move out. Thetrachea divides into right and left main bronchi, which further divideeventually into terminal bronchioles. The bronchi make up the conductingairways, and do not take part in gas exchange. Further divisions of theairways lead to the respiratory bronchioles, and eventually to thealveoli. The alveolated region of the lung is where the gas exchangetakes place, and is referred to as the respiratory zone. See West,Respiratory Physiology—the essentials.

A range of respiratory disorders exist.

Obstructive Sleep Apnea (OSA), a form of Sleep Disordered Breathing(SDB), is characterized by occlusion or obstruction of the upper airpassage during sleep. It results from a combination of an abnormallysmall upper airway and the normal loss of muscle tone in the region ofthe tongue, soft palate and posterior oropharyngeal wall during sleep.The condition causes the affected patient to stop breathing for periodstypically of 30 to 120 seconds duration, sometimes 200 to 300 times pernight. It often causes excessive daytime somnolence, and it may causecardiovascular disease and brain damage. The syndrome is a commondisorder, particularly in middle aged overweight males, although aperson affected may have no awareness of the problem. See U.S. Pat. No.4,944,310 (Sullivan).

Cheyne-Stokes Respiration (CSR) is a disorder of a patient's respiratorycontroller in which there are rhythmic alternating periods of waxing andwaning ventilation, causing repetitive de-oxygenation and re-oxygenationof the arterial blood. It is possible that CSR is harmful because of therepetitive hypoxia. In some patients CSR is associated with repetitivearousal from sleep, which causes severe sleep disruption, increasedsympathetic activity, and increased afterload. See U.S. Pat. No.6,532,959 (Berthon-Jones).

Obesity Hyperventilation Syndrome (OHS) is defined as the combination ofsevere obesity and awake chronic hypercapnia, in the absence of otherknown causes for hypoventilation. Symptoms include dyspnea, morningheadache and excessive daytime sleepiness.

Chronic Obstructive Pulmonary Disease (COPD) encompasses any of a groupof lower airway diseases that have certain characteristics in common.These include increased resistance to air movement, extended expiratoryphase of respiration, and loss of the normal elasticity of the lung.Examples of COPD are emphysema and chronic bronchitis. COPD is caused bychronic tobacco smoking (primary risk factor), occupational exposures,air pollution and genetic factors. Symptoms include: dyspnea onexertion, chronic cough and sputum production.

Neuromuscular Disease (NMD) is a broad term that encompasses manydiseases and ailments that impair the functioning of the muscles eitherdirectly via intrinsic muscle pathology, or indirectly via nervepathology. Some NMD patients are characterised by progressive muscularimpairment leading to loss of ambulation, being wheelchair-bound,swallowing difficulties, respiratory muscle weakness and, eventually,death from respiratory failure. Neuromuscular disorders can be dividedinto rapidly progressive and slowly progressive: (i) Rapidly progressivedisorders: Characterised by muscle impairment that worsens over monthsand results in death within a few years (e.g. Amyotrophic lateralsclerosis (ALS) and Duchenne muscular dystrophy (DMD) in teenagers);(ii) Variable or slowly progressive disorders: Characterised by muscleimpairment that worsens over years and only mildly reduces lifeexpectancy (e.g. Limb girdle, Facioscapulohumeral and Myotonic musculardystrophy). Symptoms of respiratory failure in NMD include: increasinggeneralised weakness, dysphagia, dyspnea on exertion and at rest,fatigue, sleepiness, morning headache, and difficulties withconcentration and mood changes.

Chest wall disorders are a group of thoracic deformities that result ininefficient coupling between the respiratory muscles and the thoraciccage. The disorders are usually characterised by a restrictive defectand share the potential of long term hypercapnic respiratory failure.Scoliosis and/or kyphoscoliosis may cause severe respiratory failure.Symptoms of respiratory failure include: dyspnea on exertion, peripheraloedema, orthopnea, repeated chest infections, morning headaches,fatigue, poor sleep quality and loss of appetite.

Otherwise healthy individuals may take advantage of systems and devicesto prevent respiratory disorders from arising.

2.2.2 Therapy

Nasal Continuous Positive Airway Pressure (CPAP) therapy has been usedto treat Obstructive Sleep Apnea (OSA). The hypothesis is thatcontinuous positive airway pressure acts as a pneumatic splint and mayprevent upper airway occlusion by pushing the soft palate and tongueforward and away from the posterior oropharyngeal wall.

Non-invasive ventilation (NIV) provides ventilator support to a patientthrough the upper airways to assist the patient in taking a full breathand/or maintain adequate oxygen levels in the body by doing some or allof the work of breathing. The ventilator support is provided via apatient interface. NIV has been used to treat CSR, OHS, COPD, MD andChest Wall disorders.

Invasive ventilation (IV) provides ventilatory support to patients thatare no longer able to effectively breathe themselves and is providedusing a tracheostomy tube.

Ventilators may control the timing and pressure of breaths pumped intothe patient and monitor the breaths taken by the patient. The methods ofcontrol and monitoring patients typically include volume-cycled andpressure-cycled methods. The volume-cycled methods may include amongothers, Pressure-Regulated Volume Control (PRVC), Volume Ventilation(VV), and Volume Controlled Continuous Mandatory Ventilation (VC-CMV)techniques. The pressure-cycled methods may involve, among others,Assist Control (AC), Synchronized Intermittent Mandatory Ventilation(SIMV), Controlled Mechanical Ventilation (CMV), Pressure SupportVentilation (PSV), Continuous Positive Airway Pressure (CPAP), orPositive End Expiratory Pressure (PEEP) techniques.

2.2.3 Systems

One known device used for treating sleep disordered breathing is the S9Sleep Therapy System, manufactured by ResMed. Ventilators such as theResMed Stellar™ Series of Adult and Paediatric Ventilators may providesupport for invasive and non-invasive non-dependent ventilation for arange of patients for treating a number of conditions such as but notlimited to NMD, OHS and COPD.

The ResMed Elisée™ 150 ventilator and ResMed VS III™ ventilator mayprovide support for invasive and non-invasive dependent ventilationsuitable for adult or paediatric patients for treating a number ofconditions. These ventilators provide volumetric and barometricventilation modes with a single or double limb circuit.

A system may comprise a PAP Device/ventilator, an air circuit, ahumidifier, a patient interface, and data management.

2.2.4 Patient Interface

A patient interface may be used to interface respiratory equipment toits user, for example by providing a flow of breathable gas. The flow ofbreathable gas may be provided via a mask to the nose and/or mouth, atube to the mouth or a tracheostomy tube to the trachea of the user.Depending upon the therapy to be applied, the patient interface may forma seal, e.g. with a face region of the patient, to facilitate thedelivery of gas at a pressure at sufficient variance with ambientpressure to effect therapy, e.g. a positive pressure of about 10 cmH2O.For other forms of therapy, such as the delivery of oxygen, the patientinterface may not include a seal sufficient to facilitate delivery tothe airways of a supply of gas at a positive pressure of about 10 cmH2O.

The design of a patient interface presents a number of challenges. Theface has a complex three-dimensional shape. The size and shape of nosesvaries considerably between individuals. Since the head includes bone,cartilage and soft tissue, different regions of the face responddifferently to mechanical forces. The jaw or mandible may move relativeto other bones of the skull. The whole head may move during the courseof a period of respiratory therapy.

As a consequence of these challenges, some masks suffer from being oneor more of obtrusive, aesthetically undesirable, costly, poorly fitting,difficult to use, and uncomfortable especially when worn for longperiods of time or when a patient is unfamiliar with a system. Forexample, masks designed solely for aviators, mask designed as part ofpersonal protection equipment, or for the administration of anaestheticsmay be tolerable for their original application, but nevertheless beundesirably uncomfortable to be worn for extended periods of time. Thisis even more so if the mask is to be worn during sleep.

2.2.4.1 Seal-Forming Portion

Patient interfaces may include a seal-forming portion.

A patient interface may be partly characterised according to the designintent of where the seal-forming portion is to engage with the face inuse. In one form of patient interface, a seal-forming portion maycomprise two sub-portions to engage with respective left and rightnares. In one form of patient interface, a seal-forming portion maycomprise a single element that surrounds both nares in use. Such singleelement may be designed to for example overlay an upper lip region and anasal bridge region of a face. In one form of patient interface aseal-forming portion may comprise an element that surrounds a mouthregion in use, e.g. by forming a seal on a lower lip region of a face.In one form of patient interface, a seal-forming portion may comprise asingle element that surrounds both nares and a mouth region in use.These different types of patient interfaces may be known by a variety ofnames by their manufacturer including nasal masks, full-face masks,nasal pillows, nasal puffs and oro-nasal masks.

One type of seal-forming portion extends around the periphery of thepatient interface, and is intended to seal against the user's face whenforce is applied to the patient interface with the seal-forming portionin confronting engagement with the user's face. The seal-forming portionmay include an air or fluid filled cushion, or a moulded or formedsurface of a resilient seal element made of an elastomer such as arubber. With this type of seal-forming portion, if the fit is notadequate, there will be gaps between the seal-forming portion and theface, and additional force will be required to force the patientinterface against the face in order to achieve a seal.

Another type of seal-forming portion incorporates a flap seal of thinmaterial so positioned about the periphery of the mask so as to providea self-sealing action against the face of the user when positivepressure is applied within the mask. Like the previous style of sealforming portion, if the match between the face and the mask is not good,additional force may be required to effect a seal, or the mask may leak.Furthermore, if the shape of the seal-forming portion does not matchthat of the patient, it may crease or buckle in use, giving rise toleaks.

Another type of seal-forming portion may comprise a friction-fitelement, e.g. for insertion into a naris.

Another form of seal-forming portion may use adhesive to effect a seal.Some patients may find it inconvenient to constantly apply and remove anadhesive to their face.

A range of patient interface seal-forming portion technologies aredisclosed in the following patent applications, assigned to ResMedLimited: WO 1998/004,310; WO 2006/074,513; WO 2010/135,785.

2.2.4.2 Positioning and Stabilising

A seal-forming portion of a patient interface used for positive airpressure therapy is subject to the corresponding force of the airpressure to disrupt a seal. Thus a variety of techniques have been usedto position the seal-forming portion, and to maintain it in sealingrelation with the appropriate portion of the face.

One technique is the use of adhesives. See for example US Patentpublication US 2010/0000534.

Another technique is the use of one or more straps and stabilisingharnesses. Many such harnesses suffer from being one or more ofill-fitting, bulky, uncomfortable and awkward to use.

Document WO 2013/026092 A1, which is hereby incorporated by reference inits entirety, discloses a headgear, mask and accessory components. FIG.4 b shows a perspective view of the headgear 100 and FIG. 4 c shows aplan view of the headgear 100 according to WO 2013/026092. The headgear100 includes two lateral crown sections or straps 102, 104 and an uppercrown section or strap 106 forming a ring-like shape or crown strapassembly configured to fit the crown of a patient's head. Upper maskconnection straps 108 and lower mask connection straps 110 are adaptedto hold a mask in place on a patient's face. The upper and lower maskconnection straps 108, 110 are connected to the upper crown strap 106and/or the lateral crown straps 102, 104 by ultrasonic welding (shadedareas in the respective connection portions as shown in FIG. 4 c ). Thelower straps 110 are connected such that a joint 115 interconnects thelower straps 110. The joint 115 also interconnects the end portions 102a, 104 a of the lateral crown straps 102, 104 and the lower straps 110.In other words, the lateral crown straps 102, 104 both comprise at theirlower ends free end portions 102 a, 104 a forming the neck part of aring-like crown covering assembly. The end portions 102 a, 104 a areconnected by a joint 115 (see FIGS. 4 b and 4 c ). The joint 115 issubstantially parallel to the sagittal or median plane of a user.

Moreover the headgear of the mask Mirage FX™ sold by ResMed Limitedcomprises a crown section made of one piece of material and being cutout from one material sheet which is then looped and stitched togetherat the same position as the joint of WO 2013/026092 in order to form aring-like crown covering assembly.

A joint located in the sagittal or median plane of the user may causediscomfort in the nape of the neck, particularly if the end portions ofthe lateral crown sections are stitched together. Moreover, these jointsrequire a certain minimum width in order to securely join the two endportions of the lateral crown sections. Such an increased widthincreases the overall footprint of the headgear. Headgears for PAPtherapy are generally used during the night for extended periods. Thefootprint is critical for overall sleeping comfort since an increasedfootprint leads to a reduced air circulation at portions covered by theheadgear and the user might sweat in covered areas. The increasedfootprint additionally leads to an increased usage of headgear materialthereby increasing material costs of a headgear. Moreover, headgearswith an increased footprint may be considered more intrusive, whichgenerally decreases the users' willingness to wear such “medicaldevices”. The manufacturing of the stitch is complex and requiresincreased material wastage. The whole headgear of the prior art masksare often manufactured of the same material which limits designvariation and costs savings by using different (cheaper) materials.

Presently available prior art headgears with lateral crown sectionsbeing connected at its end portions are limited concerning a furtheroptimization of the distribution of the mask holding forces around theusers' head and/or of the adaption of the headband's general overallshape to the head shape of the average user.

2.2.4.3 Vent Technologies

Some forms of patient interface systems may include a vent to allow thewashout of exhaled carbon dioxide. Many such vents are noisy. Others mayblock in use and provide insufficient washout. Some vents may bedisruptive of the sleep of a bed-partner 1100 of the patient 1000, e.g.through noise or focussed airflow.

ResMed Limited has developed a number of improved mask venttechnologies. See WO 1998/034,665; WO 2000/078,381; U.S. Pat. No.6,581,594; US Patent Application; US 2009/0050156; US Patent Application2009/0044808.

Table of noise of prior masks (ISO 17510-2: 2007, 10 cmH₂O pressure at 1m) A-weighted A-weighted sound power sound level dB(A) pressure dB(A)Year Mask name Mask type (uncertainty) (uncertainty) (approx.) Glue-on(*) nasal 50.9 42.9 1981 ResCare nasal 31.5 23.5 1993 standard (*)ResMed nasal 29.5 21.5 1998 Mirage (*) ResMed nasal 36 (3) 28 (3) 2000UltraMirage ResMed nasal 32 (3) 24 (3) 2002 Mirage Activa ResMed nasal30 (3) 22 (3) 2008 Mirage Micro ResMed nasal 29 (3) 22 (3) 2008 MirageSoftGel ResMed nasal 26 (3) 18 (3) 2010 Mirage FX ResMed nasal 37 292004 Mirage pillows Swift (*) ResMed nasal 28 (3) 20 (3) 2005 MirageSwift II pillows ResMed nasal 25 (3) 17 (3) 2008 Mirage Swift pillows LT(* one specimen only, measured using test method specified in ISO3744 inCPAP mode at 10 cmH₂O)

Sound pressure values of a variety of objects are listed below

A-weighted sound Object pressure dB(A) Notes Vacuum cleaner: Nilfisk 68ISO3744 at 1 m Walter Broadly Litter Hog: B+ distance GradeConversational speech 60 1 m distance Average home 50 Quiet library 40Quiet bedroom at night 30 Background in TV studio 20

2.2.4.4 Nasal Pillow Technologies

One form of nasal pillow is found in the Adam Circuit manufactured byPuritan Bennett. Another nasal pillow, or nasal puff is the subject ofU.S. Pat. No. 4,782,832 (Trimble et al.), assigned to Puritan-BennettCorporation.

ResMed Limited has manufactured the following products that incorporatenasal pillows: SWIFT nasal pillows mask, SWIFT II nasal pillows mask,SWIFT LT nasal pillows mask, SWIFT FX nasal pillows mask and LIBERTYfull-face mask. The following patent applications, assigned to ResMedLimited, describe nasal pillows masks: International Patent ApplicationWO2004/073,778 (describing amongst other things aspects of ResMed SWIFTnasal pillows), US Patent Application 2009/0044808 (describing amongstother things aspects of ResMed SWIFT LT nasal pillows); InternationalPatent Applications WO 2005/063,328 and WO 2006/130,903 (describingamongst other things aspects of ResMed LIBERTY full-face mask);International Patent Application WO 2009/052,560 (describing amongstother things aspects of ResMed SWIFT FX nasal pillows).

3 BRIEF SUMMARY OF THE TECHNOLOGY

The present technology is directed towards providing medical devicesused in the diagnosis, amelioration, treatment, or prevention ofrespiratory disorders having one or more of improved comfort, cost,efficacy, ease of use and manufacturability.

A first aspect of the present technology relates to apparatus used inthe diagnosis, amelioration, treatment or prevention of a respiratorydisorder.

Another aspect of the present technology relates to methods used in thediagnosis, amelioration, treatment or prevention of a respiratorydisorder.

Another aspect of the present technology is directed towards overcomingor ameliorating the aforementioned drawbacks of the prior art andproviding an improved and/or alternative and/or additional neck strap,crown strap assembly and/or headgear.

Another aspect of the present technology is directed towards increasingthe comfort of a headgear. Another aspect is directed towards reducingthe manufacturing costs, and the material costs. Another aspect is toimprove the overall appearance of a headgear.

Another aspect of the present technology is directed towards a neckstrap for a headgear. In an example, the neck strap comprises firstand/or second lower connection portions for connecting first and/orsecond lower mask connection straps. Additionally, the neck strap maycomprise first and/or second upper connection portions for connecting afirst and/or second lateral (crown) straps.

In an example of the present technology, headgear will be taken to meana form of positioning and stabilizing structure designed for use on apatient's head. In an example, the headgear comprises a collection ofone or more straps, ties and stiffeners configured to locate and retaina patient interface in position on a patient's face for delivery ofrespiratory therapy. Some ties may be formed of a soft, flexible,elastic material such as a laminated composite of foam and fabric.

An aspect of the present technology relates to a neck strap for aheadgear that eliminates the joint in the sagittal or median plane. Thusno stitch is provided in the plane through the middle of the head. Astitch in that area of the neck may be uncomfortable. Having no joint inthat area may also allow the width of the neck strap in that area to bereduced, which may lead to a reduced overall footprint. The materialcosts may also be reduced. Advantageously, the positioning of the strapsmay be further improved and the overall shape of the headgear may bebetter adapted to the average user.

Another aspect of the present technology relates to a neck strap andcrown straps for a headgear structured to allow for additional headmobility in use without impacting the back of the patient's neck and theforce applied to the patient by the patient interface and seal formingstructure. In an example of the present technology, the neck strapincludes a smaller overall size and a curvature in an upper edge thereofthat allows more head mobility in a posterior direction.

In an example of the present technology, the neck strap may besubstantially flat. The neck strap may comprise at least one, e.g., atleast two or two opposing major side edge(s) or major side surface(s).In an example, the at least one of the (opposing) major side edge(s)comprise(s) a curved or arc-shaped portion. The curvature of the majorside edge may be concave. In an example, the two major side edges arecurved. The neck strap may have at least partially a reduced widthbetween opposing major side edges, particularly in the curved portion.The neck strap may comprise at least one, e.g., at least two or twoopposing minor side edge(s) or minor side surface(s). The major sideedge(s) may interconnect the (opposing) minor edges. A first lowerconnection portion and/or a first upper connection portion may belocated at a first of the two minor side edges. A second lowerconnection portion and/or a second upper connection portion may belocated at a second of the two minor side edges.

In an example, the first lower connection portion may extendsubstantially parallel, e.g., parallel, to an adjacent (lower connectionedge) portion of the respective minor side edge. Additionally oralternatively, the second lower connection portion may extendsubstantially parallel, e.g., parallel, to an adjacent (lower connectionedge) portion of the respective minor side edge. The first upperconnection portion may extend substantially parallel, e.g., parallel, toan adjacent (first upper connection edge) portion of the respectiveminor side edge. Additionally or alternatively, the second upperconnection portion may extend substantially parallel, e.g., parallel, toan adjacent (second upper connection edge) portion of the respectiveminor side edge. The first and/or second upper or lower connection edgeportion(s) may be (an) edge portion(s) of the at least one minor sideedge, which may be located in the transition of neck strap to thestrap(s) fixed to the respective portion of the neck strap.

In an example, the first and/or second lower connection portion may beoriented substantially perpendicular, e.g., perpendicular, to the mainaxis of extension of the respective first and/or second lower maskconnection strap. In an example, the first and/or second (lowerconnection edge) portion(s) of the minor side edge(s) may be orientedsubstantially perpendicular, e.g., perpendicular, to the main axis ofextension of the respective first and/or second lower mask connectionstrap. The first and/or second lower mask connection straps and the neckstrap may be configured as one piece, e.g., cut out of one materialsheet. Such a one piece neck strap may be connected via upper firstand/or second connection portion(s) to the at least one lateral crownstrap. The costs for welding may be reduced while the material waste mayonly be moderately increased if at all.

In an example, the first and/or second upper connection portion(s) maybe oriented in an acute angle to the main axis of extension of therespective first and second lateral crown strap, which is connectable tothe neck strap. In an example, the first and/or second (upper connectionedge) portion(s) of the minor side edge(s) may be oriented in an acuteangle to the main axis of extension of the respective first and/orsecond lateral crown strap to be connected to the neck strap. In anexample, respective first and/or second transitional edge portion(s) maybe connected (substantially) tangentially with the respective firstand/or second (upper connection edge) portion(s) of the minor sideedge(s). Respective first and/or second transitional edge portion(s) mayintersect with respective first and/or second (lower connection edge)portion(s) of the minor side edge(s) in an angle, e.g., between 60° to120°, between 75° to 105°, about 90°.

In an example, the neck strap may be symmetrical to a first axis,wherein the first axis in the application position is substantiallyparallel, e.g., parallel, to the sagittal plane, e.g., to the medianplane, of a user. A second axis of the neck strap may extendperpendicular to the first axis. The width perpendicular to the secondaxis of the neck strap may be lowest in the curved portion of the majorside edge(s). The width perpendicular to the second axis may be highestat a cross-section in which a major side edge intersects with a minorside edge, e.g., in which a major side edge intersects with the first orsecond upper connection edge portion. In an example, at least one majorside edge and/or at least one minor side edge may be rounded. In anexample, the neck strap may be adapted to be used for a headgear, forinstance with upper and lower mask connection straps e.g., holding abreathing mask. The breathing mask may be a nasal mask, a mouth mask ora full face mask, e.g., for a PAP therapy. The neck strap may be adaptedfor a headgear comprising a three dimensionally formed crown strapassembly.

Another aspect of the present technology relates to a threedimensionally formed crown strap assembly for or of a headgear. Thecrown strap assembly may comprise at least one, e.g., one, top crownstrap, at least two, e.g., two, lateral crown straps and/or a neckstrap. The top crown strap and/or the at least two lateral crown strapsmay be configured as separate elements. The separate elements may bejoined together during the manufacturing process. Alternatively, the topcrown strap and/or the at least two lateral crown straps may beconfigured as or made of one piece. In one example, the top crown strapand the at least two lateral crown straps may be cut out of one materialsheet. The crown strap assembly may have a generally round threedimensional shape, e.g., that cups the parietal bone and/or occipitalbone of the patient's head in use. The crown strap may have a 3D contourcurve substantially to fit to the shape of a user's crown/back of auser's head. The straps may at least partially not extend in the sameplane thereby forming a three-dimensional shape of the crown strapassembly. The top crown strap may be located on the top of the crown inthe application position. The top crown strap may extend between a firstand second upper mask connection straps. The mask connection straps mayextend to the forehead region of the user. In the application position,the neck strap may form the lower part of the ring-like crown strapassembly.

In an example, the lateral crown straps may be located on either side ofthe crown in the application position. Two lateral crown straps and/orthe neck strap may be arranged so as to build a V-shape in a plane viewand/or in the application position. The top crown strap and/or at leastone of the lateral crown straps may be strap elements having an(substantially) elongated shape. In an example, a “substantiallyelongated” strap is a strap with slightly arc-shaped sides. A deviationfrom the rectangular shape in a width direction may be less than twicethe width of the strap. In an example, a strap having a significantL-shape or a significantly curved shape may not be considered as asubstantially elongated strap. Substantially elongated strapsadvantageously reduce the material waste. At least two of the lateralcrown straps may have (substantially) the same length. At least two ofthe lateral crown straps may have a minor-inverted shape. At least oneend of the at least one lateral crown strap may have an increased widthcompared to another portion of the respective strap.

In an example, at least one end, e.g., both ends of at least one lateralcrown strap may comprise a front side or front end wall, which extendsin an acute angle to the strap's main axis. The acute angle between thefront side and the strap's main axis may be (substantially) equal to theacute angle of the first or second upper connection portion and/or theadjacent (upper connection edge) portion of the minor side edge to thestrap's main axis. The main axis of at least one lateral crown strap may(substantially) extend straight. In an example, the main axis of the atleast one top crown strap (substantially) extends as a curved line. Thefront side of at least one end of at least one lateral crown strapand/or of the top crown strap may comprise at least one stepped portion.The crown strap assembly may be adapted for a headgear, for instancewith upper and lower mask connection straps, e.g., adapted for holding abreathing mask. The breathing mask may be a nasal mask, mouth mask or afull face mask, e.g., for a PAP therapy.

Another aspect of the present technology relates to a headgear includingthe above crown strap assembly and/or upper and/or lower mask connectionstraps. The top crown strap and at least one lateral crown strap may beconnected at and/or via portions of the upper mask connection straps.Such joints may be constructed as a thinned region to encourage bending.The thinned region may function as a flex point or hinge (e.g., a livinghinge) to provide increased flexibility where desired. The flex point orhinge may be reinforced using hot-melt seam tape, or a thinner fabriclayer with an adhesive backing, or other reinforcement methods. Such ahinge feature of the connection may permit the headgear to betteraccommodate the shape of a patient's head. A combination of linear andnonlinear joints may be utilized to achieve a desired level offlexibility and direction of flexion, as well as a desired level ofthree dimensional shaping to a component made up of a series of partswhich were originally a flat material (such as fabric or paper, forexample). Such shaping may include darts, tucks, gathers, or a curvedseam. An example joint is depicted in FIG. 3-2 of WO 2013/026092 A1which is hereby incorporated by reference.

In an example, the first and second lower mask connection straps may beconnected to the neck strap. In an example, the headgear comprisesadjustment or fastening members, e.g., with a hook material and a loopmaterial.

In an example, at least two straps selected from the group of maskconnection straps, top crown strap lateral crown straps, and/or neckstrap may be made of a different material. In an example, at least oneof the mask connection straps is made of a different material comparedto the top crown strap and/or the two lateral crown straps. The neckstrap may be made of a different material compared to the top crownstrap, the at least one lateral crown strap(s) and/or at least one upperand/or lower mask connection strap. At least one strap selected from thegroup of mask connection straps, top crown strap, lateral crown straps,and/or neck strap may at least partially be made of or comprise nylonand/or lycra. At least a portion of the top crown strap, the lateralcrown straps and/or the neck strap may comprise different layers, e.g.,of different materials. Different layers may be welded one to another.In an example, the strap may comprise different layers of differentmaterials, e.g. an outer layer of an aesthetically pleasing materialand/or an inner layer facing the patients head in an applicationposition made of a soft and/or pleasing material. For example, thestraps forming the crown assembly may be made of an inexpensive and/orcomfortable material. In an example, different materials for differentlayers of a strap portion and/or different straps may be selecteddepending on the specific properties/functions/requirements. In anexample, the headgear may be BPA-free and Gelamid® may be applied atleast for portions of the strap. All above straps may be cut of a sheetmaterial by ultrasonic cutting.

In an example, a strap may be a single layer component such as a textileor fabric, or a composite or multiple layer components such as fabricand foam composites, or outer fabric layers and inner spacer fabrics.The straps may be made of a spandex or elastane/foam composite, or maybe formed of other suitable materials (such as a 3D spacer fabric or adouble-knit interlock fabric). These straps may be cut from a sheet ofmaterial (e.g., flame laminated), or cut from a roll of narrow fabricstrap and then thermoformed and ultrasonically welded to create roundededges before being ultrasonically welded together. The straps may have ageometry that allows them to be nested on the sheet to increase yield,e.g., the geometry may be substantially linear.

In some examples, tape may be overlaid with a thin fabric layer having athickness of about 0.1 mm and about 1 mm to maintain a desirable softsurface finish. Such thermoplastic sheets may be made from, for example:polyurethane (TPU), polyester, polyamide, polyolefin and aliphaticurethanes. These materials may be customized to provide the optimumperformance characteristics for specific applications, and may beproduced in a range of colors, opacities, and surface finishes desiredfor the end use of patient interface equipment for the treatment ofsleep disordered breathing, such as in headgear or a mask arrangement.Materials having differing degrees of flexibility may be combined in analternating manner to form a controlled flex region. Components may bestacked one on top of the other and ultrasonically welded together in amanner that leaves no space therebetween. The patient interfacecomponent may be constructed of a soft material, e.g., a soft fabric.

In an example, the thickness of the top crown strap and/or lateral crownstraps may be at least partially about 3.8 mm (+−0.5 mm). In an example,the thickness of the neck strap may be at least partially about 4.2 mm(+−0.5 mm). In an example, the thickness of the mask connection strapsmay be at least partially about 2.5 mm (+−0.5 mm).

In an example, at least two straps selected from the group of maskconnection straps, top crown strap, lateral crown straps, and/or neckstrap may be connected by welding, e.g., by ultrasonic welding.Exemplary welding is explained in detail in the summary of technology inthe publication WO2013/026092 A1 which is incorporated by reference. Inparticular, FIG. 3-1 and FIG. 3-2 of WO2013/026092 A1 depict an exampleof the welding of the top crown strap and/or lateral crown straps.Portions of the top crown strap and the upper mask connection straps mayoverlap and portions of the lateral crown straps and upper maskconnection straps also may overlap. These members may be placed in anultrasonic welding tool, e.g., such as that disclosed in WO2013/026092.An advantage of the ultrasonic welding process is that a flush or buttjoint does not increase the thickness of the components at the joint andis visually appealing, unlike stitching where components must beoverlapped and which results in an uneven thickness. Even if the edgesof the two or more components are butted together and stitched withoutany or substantial overlapping, the stitches will create a rougher,stiffened and raised joint. Further, the ultrasonic flush or butt jointmay result in a smooth connection that may reduce skin irritation,chaffing or facial marking, even when reinforced with seam reinforcementtape. An advantage of using an overlapped ultrasonic weld variation isthat multiple components may be joined in a single machine in oneoperation. Furthermore, the ultrasonic welding process may be designedsuch that the joint is embodied as a thinned region or thinned portionbetween the components.

In an example, the width of the top crown strap and/or lateral crownstraps may, at least partially, be reduced compared to the width of atleast one of the mask connection straps. Accordingly, the footprint maybe further reduced and the material usage may be reduced, too. The widthof the top, lateral or neck strap(s) and thus the footprint may be(additionally) be reduced by using different materials, different strapthicknesses and/or different compositions. Different materials and/orcheaper materials may be used for some parts or portions of a headgear,e.g., with the same seal support efficacy and/or comfort. The neck strapmay have an increased thickness compared to at least one lower maskconnection strap. This may increase the comfort.

Another aspect of the present technology relates to a neck strap for aheadgear including first and second lower connection portions forconnecting first and second lower mask connection straps, and first andsecond upper connection portions for connecting a first and secondlateral crown straps. The neck strap may be substantially flat. The neckstrap may comprise two opposing major side edges. The at least one ofthe opposing major side edges may comprise a curved portion. Thecurvature of the major side edge may be concave. The two major sideedges may be curved and the neck strap may have at least partially areduced width between opposing major side edges in the curved portion.The neck strap may comprise two opposing minor side edges wherein themajor side edges interconnect the opposing minor edges. The first lowerconnection portion and/or the first upper connection portion may belocated at a first of the two minor side edges, and/or the second lowerconnection portion and/or the second upper connection portion may belocated at a second of the two minor side edges. The first and/or secondlower connection portion may extend substantially parallel to anadjacent portion of the respective minor side edge, and/or the firstand/or second upper connection portion may extend substantially parallelto an adjacent portion of the respective minor side edge. The firstand/or second lower connection portion and/or respective portions of theminor side edges may be oriented substantially perpendicular to the mainaxis of extension of the respective first and/or second lower maskconnection strap. The first and second upper connection portions and/orthe adjacent portions of the minor side edges may be oriented in anacute angle to the main axis of extension of the respective first andsecond lateral crown strap. Respective first and second transitionaledge portions may be connected tangentially with the respective portionsof the minor side edges adjacent to the respective first and secondupper connection portions. Respective first and second transitional edgeportions may intersect with the respective portions of the minor sideedges adjacent to the respective first and second lower connectionportions in an angle, e.g., between 60° to 120°, between 75° to 105°,about 90°. The neck strap may be symmetrical to a first axis, whereinthe first axis in the application position may be substantially parallelto the sagittal plane of a user. A second axis of the neck strap mayextend perpendicular to the first axis. The width perpendicular to thesecond axis of the neck strap may be lowest in the curved portion of themajor side edges. The width perpendicular of the second axis of the neckstrap may be highest at a cross-section in which a major side edgeintersects with a minor side edge, e.g., intersects with the respectiveportion of the minor side edge adjacent to the respective first andsecond upper connection portion. The major side edges and/or the minorside edges may be rounded. The neck strap may be adapted for a headgearwith upper and lower mask connection straps adapted for holding abreathing mask. The breathing mask may be a nasal mask, a mouth mask ora full face mask, e.g., for a PAP therapy. The neck strap may be adaptedfor a headgear comprising a three dimensionally formed crown strapassembly.

Another aspect of the present technology relates to a threedimensionally formed crown strap assembly for a headgear comprising atop crown strap, two lateral crown straps, and a neck strap inaccordance with an example of the present technology. The top crownstrap and the lateral crown straps may be configured as separateelements. The crown strap assembly may have a generally roundthree-dimensional shape that cups the parietal bone and occipital boneof the patient's head in use. The top crown strap may extend between afirst and second upper mask connection straps, and the mask connectionsstraps may extend to the forehead region of the user. The two lateralcrown straps and the neck strap may be arranged so as to build a V-shapein a plane view. The top crown strap and/or at least one of the lateralcrown straps may be separate strap elements having a substantiallyelongated shape. The lateral crown straps may have substantially thesame length. The lateral crown straps may have a minor-inverted shape.At least one end of at least one lateral crown strap may have anincreased width compared to another portion of the respective strap. Atleast one end, e.g., both ends, of at least one lateral crown strap maycomprise a front side, which extends in an acute angle to the strap'smain axis. The acute angle between the front side and the strap's mainaxis may be substantially equal to the acute angle of the first and/orsecond upper connection portion and/or the adjacent portion of the minorside edge to the strap's main axis. The main axis of at least onelateral crown strap may substantially extend straight. The main axis ofthe top crown strap may substantially extend as a curved line. The frontside of at least one end of the lateral crown strap and/or of the topcrown strap may comprise a stepped portion. The crown strap assembly maybe adapted for a headgear with upper and lower mask connection strapsadapted for holding a breathing mask. The breathing mask may be a nasalmask, mouth mask or a full face mask, e.g., for a PAP therapy.

Another aspect of the present technology relates to headgear comprisingthe crown strap assembly in accordance with an example of the presenttechnology and upper mask connection straps. The top crown strap and atleast one lateral crown strap may be connected at and/or via portions ofthe upper mask connection straps. The headgear may further comprisefirst and second lower mask connection straps connected to the neckstrap. The headgear may comprise adjustment or fastening members. Atleast two straps may be selected from the group of mask connectionstraps, top crown strap, lateral crown straps, and/or neck strap may bemade of a different material. At least one of the mask connection strapsmay be made of a different material compared to the top crown strapand/or the two lateral crown straps.

In an example, the neck strap may be made of a different materialcompared to the top crown strap and/or the lateral crown straps. Atleast one strap may be selected from the group of mask connectionstraps, top crown strap, lateral crown straps, and/or neck strap may bemade of nylon or lycra. At least a portion of the top crown strap, thelateral crown straps and/or the neck strap may comprise different layersof different materials, e.g., welded one to another. The thickness ofthe top crown strap and/or the lateral crown straps may be at leastpartially about 3.8 mm (+−0.5 mm), and/or the thickness of the neckstrap may be at least partially about 4.2 mm (+−0.5 mm), and/or thethickness of the mask connection straps may be at least partially about2.5 mm (+−0.5 mm). At least two straps selected from the group of maskconnection straps, top crown strap, lateral crown straps, and/or neckstrap may be connected by welding. The width of the top crown strapand/or lateral crown straps may be at least partially reduced comparedto the width of at least one of the mask connection straps.

Another aspect of the present technology relates to a patient interfacefor sealed delivery of a flow of breathable gas at a continuouslypositive pressure with respect to ambient air pressure to an entrance tothe patient's airways including at least entrance of a patient's nares,wherein the patient interface is configured to maintain a therapypressure in a range of about 4 cmH2O to about 30 cmH2O above ambient airpressure in use, throughout the patient's respiratory cycle, while thepatient is sleeping, to ameliorate sleep disordered breathing. Thepatient interface includes a sealing-forming structure adapted to form aseal against the patient's airways, a positioning and stabilisingstructure to maintain the seal-forming structure in sealing contact withan area surrounding an entrance to the patient's airways whilemaintaining a therapeutic pressure at the entrance to the patient'sairways, a plenum chamber pressurised at a pressure above ambientpressure in use, and a gas washout vent configured to allow a flow ofpatient exhaled CO2 to an exterior of the patient interface to minimiserebreathing of exhaled CO2 by the patient. The positioning andstabilising structure includes a headgear including a crown strapassembly, first and second upper connection straps provided to the crownstrap assembly and adapted to connect to respective upper headgearconnectors of the patient interface, and first and second lowerconnection straps provided to the crown strap assembly and adapted toconnect to respective lower headgear connectors of the patientinterface. The crown strap assembly includes a neck strap, first andsecond lateral crown straps and a top crown strap adapted to cup theparietal bone and the occipital bone of the patient's head. The neckstrap includes a one-piece man body including first and second lowerconnection portions to connect to respective first and second lowerconnection straps and first and second upper connection portions toconnect to respective first and second lateral crown straps.

An aspect of one form of the present technology is a method ofmanufacturing apparatus.

Of course, portions of the aspects may form sub-aspects of the presenttechnology. Also, various ones of the sub-aspects and/or aspects may becombined in various manners and also constitute additional aspects orsub-aspects of the present technology.

Other features of the technology will be apparent from consideration ofthe information contained in the following detailed description,abstract, drawings and claims.

4 BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

The present technology is illustrated by way of example, and not by wayof limitation, in the figures of the accompanying drawings, in whichlike reference numerals refer to similar elements including:

4.1 Treatment Systems

FIG. 1 a shows a system in accordance with the present technology. Apatient 1000 wearing a patient interface 3000, receives a supply of airat positive pressure from a PAP device 4000. Air from the PAP device ishumidified in a humidifier 5000, and passes along an air circuit 4170 tothe patient 1000.

FIG. 1 b shows a PAP device in use on a patient with a nasal mask.

FIG. 1 c shows a PAP device in use on a patient with a full-face mask.

4.2 THERAPY 4.2.1 Respiratory System

FIG. 2 a shows an overview of a human respiratory system including thenasal and oral cavities, the larynx, vocal folds, oesophagus, trachea,bronchus, lung, alveolar sacs, heart and diaphragm.

FIG. 2 b shows a view of a human upper airway including the nasalcavity, nasal bone, lateral nasal cartilage, greater alar cartilage,nostril, lip superior, lip inferior, larynx, hard palate, soft palate,oropharynx, tongue, epiglottis, vocal folds, oesophagus and trachea.

4.2.2 Facial Anatomy

FIG. 2 c is a front view of a face with several features of surfaceanatomy identified including the lip superior, upper vermillion, lowervermillion, lip inferior, mouth width, endocanthion, a nasal ala,nasolabial sulcus and cheilion.

FIG. 2 d is a side view of a head with several features of surfaceanatomy identified including glabella, sellion, pronasale, subnasale,lip superior, lip inferior, supramenton, nasal ridge, otobasion superiorand otobasion inferior. Also indicated are the directions superior &inferior, and anterior & posterior.

FIG. 2 e is a further side view of a head. The approximate locations ofthe Frankfort horizontal and nasolabial angle are indicated.

FIG. 2 f shows a base view of a nose.

FIG. 2 g shows a side view of the superficial features of a nose.

FIG. 2 h shows subcutaneal structures of the nose, including lateralcartilage, septum cartilage, greater alar cartilage, lesser alarcartilage and fibrofatty tissue.

FIG. 2 i shows a medial dissection of a nose, approximately severalmillimeters from a sagittal plane, amongst other things showing theseptum cartilage and medial crus of greater alar cartilage.

FIG. 2 j shows a front view of the bones of a skull including thefrontal, temporal, nasal and zygomatic bones. Nasal concha areindicated, as are the maxilla, mandible and mental protuberance.

FIG. 2 k shows a lateral view of a skull with the outline of the surfaceof a head, as well as several muscles. The following bones are shown:frontal, sphenoid, nasal, zygomatic, maxilla, mandible, parietal,temporal and occipital. The mental protuberance is indicated. Thefollowing muscles are shown: digastricus, masseter sternocleidomastoidand trapezius.

FIG. 2 l shows an anterolateral view of a nose.

4.3 PAP Device and Humidifier

FIG. 3 a shows a PAP device in accordance with one form of the presenttechnology.

FIG. 3 b shows a humidifier in accordance with one aspect of the presenttechnology.

FIG. 3 c shows a schematic diagram of the pneumatic circuit of a PAPdevice in accordance with one form of the present technology. Thedirections of upstream and downstream are indicated.

4.4 PATIENT INTERFACE

FIG. 4 a is a perspective view of a patient interface in accordance withone form of the present technology.

FIGS. 4 b and 4 c show a headgear having lateral crown straps with priorart end portions.

FIG. 5 is a front perspective view of headgear according to an exampleof the present technology.

FIG. 6 is an enlarged schematic rear view of a neck portion of theheadgear shown in FIG. 5 .

FIGS. 7 a and 7 b are rear plan and perspective views of the headgearshown in FIG. 5 .

FIGS. 8 a and 8 b are front plan and perspective views of headgear shownin FIG. 5 .

FIG. 9 shows a top crown strap of a crown strap assembly according to anexample of the present technology.

FIG. 10 shows a lateral crown strap of a crown strap assembly accordingto an example of the present technology.

FIG. 11 is a rear view showing headgear according to an example of thepresent technology in use on a patient with a full-face mask.

FIG. 12 is a rear side perspective view showing headgear according to anexample of the present technology in use on a patient with a full-facemask.

FIG. 13 is a side view showing headgear according to an example of thepresent technology in use on a patient with a full-face mask.

FIG. 14 is a rear view of headgear according to an example of thepresent technology.

5 DETAILED DESCRIPTION OF EXAMPLES OF THE TECHNOLOGY

Before the present technology is described in further detail, it is tobe understood that the technology is not limited to the particularexamples described herein, which may vary. It is also to be understoodthat the terminology used in this disclosure is for the purpose ofdescribing only the particular examples discussed herein, and is notintended to be limiting.

The following description is provided in relation to several exampleswhich may share one or more common characteristics and features. It isto be understood that one or more features of any one example may becombinable with one or more features of another example or otherexamples. In addition, any single feature or combination of features inany of the examples may constitute a further example.

5.1 TREATMENT SYSTEMS

In one form, the present technology comprises apparatus for treating arespiratory disorder, as shown in FIGS. 1 a-1 c . The apparatus maycomprise a flow generator or blower for supplying pressurisedrespiratory gas, such as air, to the patient 1000 via an air deliverytube 4170 leading to a patient interface 3000. The gas delivery tube4170 may be connected to an additional gas delivery tube 4180 by arotatable adapter 4190. A humidifier 5000 may also be provided tohumidify the gas. A bed partner 1100 may also be present with thepatient

5.2 THERAPY

In one form, the present technology comprises a method for treating arespiratory disorder comprising the step of applying positive pressureto the entrance of the airways of a patient 1000.

5.2.1 Nasal CPAP for OSA

In one form, the present technology comprises a method of treatingObstructive Sleep Apnea in a patient by applying nasal continuouspositive airway pressure to the patient.

In certain embodiments of the present technology, a supply of air atpositive pressure is provided to the nasal passages of the patient viaone or both nares.

In certain embodiments of the present technology, mouth breathing islimited, restricted or prevented.

5.3 PATIENT INTERFACE 3000

FIG. 4 a shows a non-invasive patient interface 3000 in accordance withone aspect of the present technology comprises the following functionalaspects: a seal-forming structure 3100, a plenum chamber 3200, apositioning and stabilising structure 3300 and a connection port 3600for connection to air circuit 4170. In some forms a functional aspectmay be provided by one or more physical components. In some forms, onephysical component may provide one or more functional aspects. In usethe seal-forming structure 3100 is arranged to surround an entrance tothe airways of the patient so as to facilitate the supply of air atpositive pressure to the airways.

5.3.1 Seal-Forming Structure 3100

In one form of the present technology, a seal-forming structure 3100provides a sealing-forming surface, and may additionally provide acushioning function.

A seal-forming structure 3100 in accordance with the present technologymay be constructed from a soft, flexible, resilient material such assilicone.

In one form, the seal-forming structure 3100 comprises a sealing flangeand a support flange. Preferably the sealing flange comprises arelatively thin member with a thickness of less than about 1 mm, forexample about 0.25 mm to about 0.45 mm, that extends around theperimeter of the plenum chamber 3200. Support flange may be relativelythicker than the sealing flange. The support flange is disposed betweenthe sealing flange and the marginal edge of the plenum chamber 3200, andextends at least part of the way around the perimeter. The supportflange is or includes a spring-like element and functions to support thesealing flange from buckling in use. In use the sealing flange canreadily respond to system pressure in the plenum chamber 3200 acting onits underside to urge it into tight sealing engagement with the face.

In one form the seal-forming portion of the non-invasive patientinterface 3000 comprises a pair of nasal puffs, or nasal pillows, eachnasal puff or nasal pillow being constructed and arranged to form a sealwith a respective naris of the nose of a patient.

Nasal pillows in accordance with an aspect of the present technologyinclude: a frusto-cone, at least a portion of which forms a seal on anunderside of the patient's nose; a stalk, a flexible region on theunderside of the cone and connecting the cone to the stalk. In addition,the structure to which the nasal pillow of the present technology isconnected includes a flexible region adjacent the base of the stalk. Theflexible regions can act in concert to facilitate a universal jointstructure that is accommodating of relative movement-both displacementand angular—of the frusto-cone and the structure to which the nasalpillow is connected. For example, the frusto-cone may be axiallydisplaced towards the structure to which the stalk is connected.

In one form the non-invasive patient interface 3000 comprises aseal-forming portion that forms a seal in use on an upper lip region(that is, the lip superior) of the patient's face.

In one form the non-invasive patient interface 3000 comprises aseal-forming portion that forms a seal in use on a chin-region of thepatient's face.

5.3.2 Plenum Chamber 3200

Preferably the plenum chamber 3200 has a perimeter that is shaped to becomplementary to the surface contour of the face of an average person inthe region where a seal will form in use. In use, a marginal edge of theplenum chamber 3200 is positioned in close proximity to an adjacentsurface of the face. Actual contact with the face is provided by theseal-forming structure 3100. Preferably the seal-forming structure 3100extends in use about the entire perimeter of the plenum chamber 3200.

5.3.3 Vent 3400

In one form, the patient interface 3000 includes a vent 3400 constructedand arranged to allow for the washout of exhaled carbon dioxide.

One form of vent 3400 in accordance with the present technologycomprises a plurality of holes, for example, about 20 to about 80 holes,or about 40 to about 60 holes, or about 45 to about 55 holes.

Preferably the vent 3400 is located in the plenum chamber 3200.Alternatively, the vent 3400 is located in a decoupling structure 3500,e.g. a swivel.

5.3.4 Decoupling Structure(s) 3500

In one form the patient interface 3000 includes at least one decouplingstructure 3500, for example a swivel or a ball and socket.

5.3.5 Connection Port 3600

Connection port 3600 allows for connection to the air circuit 4170.

5.3.6 Forehead Support 3700

In one form, the patient interface 3000 includes a forehead support3700.

5.3.7 Anti-Asphyxia

In one form, the patient interface 3000 includes an anti-asphyxia valve.

5.3.8 Ports

In one form of the present technology, a patient interface 3000 includesone or more ports, that allow access to the volume within the plenumchamber 3200. In one form this allows a clinician to supply supplementaloxygen. In one form this allows for the direct measurement of a propertyof gases within the plenum chamber 3200, such as the pressure.

5.3.9 Positioning and Stabilising Structure 3300

In an example, the seal-forming portion 3100 of the patient interface3000, e.g., breathing mask (e.g., nasal mask, mouth mask, or a full-facemask for PAP therapy), of the present technology is held in sealingposition in use by the positioning and stabilising structure 3300.

FIG. 5 depicts a front perspective view of a positioning and stabilizingstructure in the form of headgear 10 according to an example of thepresent technology. The headgear 10 includes a crown assembly or crownstrap assembly 15, upper connection straps or upper mask connectionstraps 24, 27 provided to the crown assembly 15 and adapted to connectto upper headgear connectors of the patient interface, and lowerconnection straps or lower mask connection straps 22, 25 provided to thecrown assembly 15 and adapted to connect to lower headgear connectors ofthe patient interface. Crown assembly 15 comprises neck strap 1, lateralcrown straps 14, 17 and top crown strap 18. Neck strap 1 is connected tolateral crown straps 14, 17 as well as to lower connection straps 22,25. Lateral crown straps 14, 17 and top crown strap 18 are connected inthinned connecting portions 14 a, 17 a, 18 a (e.g., see FIGS. 7 a and 7b ) providing increased flexibility. In the illustrated example, theconnecting portions 14 a, 17 a, 18 a are arranged in an at least partlyoverlapping fashion on the upper connection straps 24, 27 as shown inFIGS. 7 a and 7 b . The connecting portions 14 a, 17 a, 18 a may have aV-shape and may be at least partially spaced apart from each other. Theconnecting portions 14 a, 17 a, 18 a may be welded portions. The upperand lower connection straps 24, 27, 22, 25 are each provided withadjustment or fastening members 30, e.g., hook and loop materials.

As noted above, the top crown strap 18 and the lateral crown straps 14,17 may be connected at and/or via portions of the upper mask connectionstraps 24, 27. Such joints may be constructed as a thinned region orthinned connection portions 14 a, 17 a, 18 a to encourage bending. Thethinned region may function as a flex point or hinge (e.g., a livinghinge) to provide increased flexibility where desired. The flex point orhinge may be reinforced using hot-melt seam tape, or a thinner fabriclayer with an adhesive backing, or other reinforcement methods. Such ahinge feature of the connection may permit the headgear to betteraccommodate the shape of a patient's head. A combination of linear andnonlinear joints may be utilized to achieve a desired level offlexibility and direction of flexion, as well as a desired level ofthree dimensional shaping to a component made up of a series of partswhich were originally a flat material (such as fabric or paper, forexample). Such shaping may include darts, tucks, gathers, or a curvedseam. An example joint is depicted in FIG. 3-2 of WO2013/026092 A1 whichis hereby incorporated by reference.

In an example, as shown in FIGS. 5 and 11-13 , the crown strap assembly15 may have a generally round three-dimensional shape adapted to cup theparietal bone and occipital bone of the patient's head in use. The crownstrap assembly may have a three-dimensional contour curve substantiallyto fit to the shape of a user's crown/back of a user's head. The straps1, 14, 17, 18 may at least partially not extend in the same planethereby forming a three-dimensional shape of the crown strap assembly15. The top crown strap 18 may be located on the top of the crown in theapplication position. The top crown strap 18 may extend between theupper connection straps 24, 27. As shown in FIGS. 11-13 , the upperconnection straps 24, 27 may extend to the forehead region of the user,e.g., to connect to upper headgear connectors of a forehead support ofthe patient interface. In the application position, the neck strap 1 mayform the lower part of the ring-like crown strap assembly 15.

In the illustrated example, the top crown strap 18 and the lateral crownstraps 14, 17 may be configured as separate elements. The separateelements may be joined together during the manufacturing process.Alternatively, the top crown strap and the lateral crown straps 14, 17may be configured as or made of one piece. In one example, the top crownstrap 18 and the lateral crown straps 14, 17 may be cut out of onematerial sheet.

In the illustrated example, the headgear 10 includes 8 separate strapsthat are connected (e.g., ultrasonically welded) to one another toconstruct the headgear adapted for use with the patient interface. Forexample, as shown in FIG. 14 , the crown strap assembly 15 includes 4separate straps (top crown strap 18, lateral crown straps 14 and 17, andneck strap 1) that are connected to one another in 4 junction points,J1, J2, J3, and J4. Two of the junction points J1 and J2 (referred to astop junction points) at the top of the headgear join together three ofthe straps from the crown strap assembly (i.e., the top crown strap 18and the lateral crown straps 14 and 17) and the upper mask connectionstraps 24 and 27. The other two junction points J3 and J4 (referred toas neck junction points) at the bottom of the headgear join the lateralcrown straps 14 and 17 together at opposite ends of the neck strap 1.The neck strap 1 may be separately connected (e.g., welded) to the lowermask connection straps 22 and 25.

This arrangement allows the crown strap assembly 15 to be formed fromthree substantially rectangular crown strap pieces (i.e., top crownstrap 18 and lateral crown straps 14 and 17) and then connected (e.g.,ultrasonically welded) together via the junction points with the neckstrap 1 to form the three-dimensional contoured shape adapted to fit theback of the patient's head in use.

Designing the crown strap pieces (i.e., top crown strap 18, lateralcrown straps 14 and 17, and neck strap 1) separately may allowflexibility for the crown strap pieces to be made relatively smallerwhich contributes to an increased yield and simpler process ofmanufacturing. In addition, the design of the crown strap pieces mayallow for less material wastage when cut from a sheet, e.g., due to thesubstantially rectangular shape of the crown straps 14, 17, and 18.Moreover, manufacturing the crown strap assembly in separate pieces mayallow for the substitution of materials that are less expensive, morecomfortable and/or have an aesthetically pleasing color.

However, in an alternative example, two or more straps may be configuredas or made of one piece. For example, as noted above, the top crownstrap 18 and the lateral crown straps 14 and 17 may be configured as onepiece. Also, in an example, the neck strap 1 and the lower maskconnection straps 22 and 25 may be configures as one piece.

FIG. 6 is an enlarged view of a neck strap 1 according to an example ofthe present technology. In an example, the neck strap may besubstantially flat. In an example, the neck strap 1 provides a one-piecemain body that is a separate and distinct structure from the remainingstraps of the headgear.

The main body of the neck strap 1 comprises two opposing major sideedges or major side surfaces 3, 6. In the illustrated example, the majorside edges 3, 6 each have a generally curved shape, i.e., curved orarc-shaped portion. As illustrated, the curved shape or curvature may beconcave. The major side edges 3, 6 interconnect two minor side edges orminor side surfaces 12, 13 of the main body.

Axis A-A is located in the axis of symmetry of neck strap 1. In theillustrated example, the neck strap 1 is symmetrical to the axis A-A,wherein the axis A-A in the application position is substantiallyparallel, e.g., parallel, to the sagittal plane, e.g., to the medianplane, of a user.

The two minor side edges 12, 13 are located remotely or laterally spacedfrom the axis A-A. The first minor side edge 12 comprises three edgeportions, i.e., first lower connection edge portion 2′, first upperconnection edge portion 4′, and first transitional edge portion 8. Firstlower connection edge portion 2′ is a portion that extends substantiallyparallel to an adjacent first lower connection portion 2 of neck strap1. First upper connection edge portion 4′ extends substantially parallelto an adjacent first upper connection portion 4 of neck strap 1. Firsttransitional edge portion 8 interconnects the first upper connectionedge portion 4′ with the first lower connection edge portion 2′.

The second minor side edge 13 is symmetrical to the first minor sideedge 12 and also comprises three edge portions, i.e., second lowerconnection edge portion 5′, second upper connection edge portion 7′, andsecond transitional edge portion 9. The second upper and lowerconnection edge portions 7′, 5′ as well as second transitional edgeportion 9 are arranged in the same fashion as the first upper and lowerconnection edge portions 4′, 2′ and the first transitional edge portion8. For example, the second lower connection edge portion 5′ is a portionthat extends substantially parallel to an adjacent second lowerconnection portion 5 of neck strap 1, and the second upper connectionedge portion 7′ extends substantially parallel to an adjacent secondupper connection portion 7 of neck strap 1.

The first transitional edge portion 8 intersects with first lowerconnection edge portion 2′ in an angle (3, e.g., between 60° to 120°,between 75° to 105°, approximately 90°, whereas the upper connectionedge portion 4′ intersects with the transitional edge portion 8 in atangential fashion. Similarly, the second transitional edge portion 9intersects with the lower connection edge portion 5′ in an angle (3,e.g., between 60° to 120°, between 75° to 105°, approximately 90°,whereas the upper connection edge portion 7′ intersects with thetransitional edge portion 9 in a tangential fashion.

In the illustrated example, the neck strap 1 provides a one-piece mainbody that eliminates a joint in the sagittal or median plane. Thus, nostitch is provided in the plane through the middle of the patient's headin use. A stitch in that area of the neck may be uncomfortable. Havingno joint in that area may also allow the width of the neck strap in thatarea to be reduced, which may lead to a reduced overall footprint. Thematerial costs may also be reduced. In addition, the positioning of thestraps may be further improved and the overall shape of the headgear maybe better adapted to the average patient.

As shown in FIG. 6 , the width of neck strap 1 may have at least apartially reduced width between opposing major side edges 3, 6,particularly the width w1 is reduced or lowest in the concave curvedpart of opposing major side edges 3, 6, measured in a directionperpendicular to axis B-B. Axis B-B itself is an axis perpendicular toaxis A-A. In an example, the width w1 may be in the range of about 22-25mm, e.g., about 24 mm. The width w2 perpendicular to the axis B-B may behighest at a cross-section in which a major side edge 3, 6 intersectswith a minor side edge 12, 13, e.g., in which a major side edge 3, 6intersects with the first or second upper connection edge portion 4′, 7′or the first or second lower connection edge portion 2′, 5′. In anexample, the width w2 may be in the range of about 42-26 mm, e.g., about45 mm. In an example, at least one major side edge 3, 6 and/or at leastone minor side edge 12, 13 may be rounded.

According to an example of the present technology, the neck strap 1includes a relatively smaller size and includes a curvature along theupper and lower major side edges 3, 6 to enhance comfort and mobility.In an example, as shown in FIG. 6 , the neck strap 1 may include alength L1 in the range of about 55-60 mm, e.g., 58 mm, and a length L2of about 82-90 mm, e.g., 86 mm. Also, in an example, as shown in FIG. 6, the major side edge 6 may define an angle A1 in the range of about30°-40°, e.g., 34°, and the major side edge 3 may define an angle A2 inthe range of about 65°-75°, e.g., 70°.

As best shown in FIGS. 11-13 , the smaller size and the curvature in theupper and lower side edges 3, 6 of the neck strap 1 allow for additionalhead mobility by a patient in use. For example, the smaller overall sizeof the neck strap 1 and its curvature in the upper edge 3 provideadditional spacing between the occiput of the patient and the upper edge3 such that a patient may bend their head backwards towards their spine(e.g., in a posterior direction) with an additional freedom of movementwhile avoiding contact between the upper edge 3 and the patient'socciput. Contact of the patient's occiput with the upper edge 3 of theheadgear may cause discomfort and may also apply additional force on themask connection straps 22, 24, 25, 27, which ultimately impacts theforce applied to the patient by the patient interface and sealingforming structure. Thus, the additional spacing provided by size andcurvature of the neck strap 1 provides additional mobility withoutimpacting the back of the patient's neck and the force applied to thepatient by the patient interface and sealing forming structure.

Lateral crown straps 14, 17 indicated by dotted lines in FIG. 6 areconnected or connectable to neck strap 1 in respective first and secondupper connection portions 4, 7. Lower connection straps 22, 25 depictedin dotted lines in FIG. 6 are connected or connectable to neck strap 1in respective first and second lower connection portions 2, 5. First andsecond lower connection portions 2, 5 and the first and second lowerconnection edge portions 2′, 5′ of the illustrated example extendgenerally perpendicular to the main axis of extension D-D of respectivelower connection straps 22, 25. In the illustrated example, the firstand second upper connection portions 4, 7 and the first and second upperconnection edge portions 4′, 7′ are each oriented in an acute angle α tothe main axis of extension C-C of respective first and second lateralcrown straps 14, 17 to be connected to the neck strap.

In an example, the first and/or second lower connection straps 22, 25and the neck strap 1 may be configured as one piece, e.g., cut out ofone material sheet. Such a one piece neck strap may be connected viaupper first and/or second connection portions 4, 7 to the lateral crownstraps 14, 17. In such example, the costs for welding may be reducedwhile the material waste may only be moderately increased if at all.

FIGS. 7 a and 7 b show rear views, and FIGS. 8 a and 8 b show frontviews of the headgear 10 according to an example of the presenttechnology. Each connection strap 24, 27, 22, 25 is provided with anadjustment or fastening member 30, e.g., a hook fastener. The headgearor headband in FIGS. 7 a, 7 b, 8 a, and 8 b is depicted before the finalassembly step. By connecting, e.g., welding, the top crown strap 18 tothe upper connection strap 24 and/or the lateral crown strap 14, thefinal three-dimensional crown assembly 15 is obtained. For example, thethinned connecting portion 18 a of the top crown strap 18 may beconnected to the thinned connecting portion 14 a of the lateral crownstrap 14, and the thinned connection portion 18 a may be arranged in atleast partly overlapping fashion on the upper connection strap 24.

FIG. 9 shows the (substantially) elongated shape of a top crown strap 18according to an example of the present technology. As illustrated, thetop crown strap 18 comprises a substantially curved main axis E-E (i.e.,main axis E-E substantially extends as a curved line) and stepped frontsides 19 at both ends. Each of the stepped front sides or steppedportion 19 provides a thinned connection portion 18 a adapted to connectto the lateral crown straps 14, 17 and the upper connection straps 24,27.

FIG. 10 shows a lateral crown strap 14, 17 according to an example ofthe present technology. As illustrated, each lateral crown strap 14, 17includes one stepped front side or front end wall 32, one flat or smoothfront side or front end wall 34, and a generally straight main axis C-C.The stepped front side or stepped portion 32 provides a thinnedconnection portion 14 a, 17 a adapted to connect to the top crown strap18 and the upper connection straps 24, 27. Each front side 32, 34extends in an acute angle γ to the strap's main axis C-C. In an example,the acute angle γ may be substantially equal to the acute angle α of thefirst and second upper connection portions 4, 7 and/or the adjacentfirst and second upper connection edge portions 4′, 7′ of the minor sideedges 12, 13 to the lateral crown strap's main axis C-C.

The lateral crown straps 14, 17 may be located on either side of thecrown in the application position. As best shown in FIGS. 7 a to 8 b ,the lateral crown straps 14, 17 and/or the neck strap 1 may be arrangedso as to build a V-shape in a plane view and/or in the applicationposition. The top crown strap 18 and/or at least one of the lateralcrown straps 14, 17 may be strap elements having a substantiallyelongated shape. In an example, a “substantially elongated” strap is astrap with slightly arc-shaped sides. A deviation from the rectangularshape in a width direction may be less than twice the width of thestrap. In an example, a strap having a significant L-shape or asignificantly curved shape may not be considered as a substantiallyelongated strap. Substantially elongated straps advantageously reducethe material waste. In an example, the lateral crown straps 14, 17 mayhave substantially the same length, and the lateral crown straps 14, 17may have a mirror-inverted shape. At least one end of each lateral crownstrap 14, 17 may have an increased width compared to another portion ofthe respective strap.

In an example, the width of the top crown strap 18 of FIG. 9 may bedifferent compared to the width of the lateral crown straps 14, 17,e.g., the width of the top crown strap 18 may be thinner than the widthof the lateral crown straps 14, 17. Also, in an example, the length ofthe top crown strap 18 of FIG. 9 may be different compared to the lengthof the lateral crown straps 14, 17, e.g., the length of the top crownstrap 18 may be longer than the length of the lateral crown straps 14,17. For example, the length 1 of the top crown strap 18 in FIG. 9 may bein the range of about 218-222 mm, e.g., 220 mm, and the length 1 of thelateral crown straps 14, 17 in FIG. 10 may be in the range of about113-117 mm, e.g., 115 mm.

Also, in an example, the width of the top crown strap 18 and/or lateralcrown straps 14, 17 may, at least partially, be reduced compared to thewidth of at least one of the mask connection straps 22, 24, 27, 30.Accordingly, the footprint may be further reduced and the material usagemay be reduced too. The width of the top, lateral or neck straps, 18,14, 17, 1 and thus the footprint may be additionally reduced by usingdifferent materials, different strap thicknesses and/or differentcompositions. Different materials and/or cheaper materials may be usedfor some parts or portions of a headgear, e.g., with the same sealsupport efficacy and/or comfort. In an example, the neck strap 1 mayhave an increased thickness compared to the lower mask connection straps22, 25. This may increase comfort.

In an example, at least two straps selected from the group of maskconnection straps 22, 24, 25, 27, top crown strap 18, lateral crownstraps 14, 17, and/or neck strap 1 may be made of a different material.In an example, at least one of the mask connection straps 22, 24, 25, 27is made of a different material compared to the top crown strap 18and/or the two lateral crown straps 14, 17. The neck strap 1 may be madeof a different material compared to the top crown strap 18, at least oneof the lateral crown straps 14, 17 and/or at least one upper and/orlower mask connection strap 22, 24, 25, 27. At least one strap selectedfrom the group of mask connection straps 22, 24, 25, 27, top crown strap18, lateral crown straps 14, 17, and/or neck strap 1 may at leastpartially be made of or comprise nylon and/or lycra. At least a portionof the top crown strap 18, the lateral crown straps 14, 17 and/or theneck strap 1 may comprise different layers, e.g., of differentmaterials. Different layers may be welded one to another. In an example,the strap may comprise different layers of different materials, e.g. anouter layer of an aesthetically pleasing material and/or an inner layerfacing the patients head in an application position made of a softand/or pleasing material. For example, the straps forming the crownassembly 15 may be made of an inexpensive and/or comfortable material.In an example, different materials for different layers of a strapportion and/or different straps may be selected depending on thespecific properties/functions/requirements. In an example, the headgearmay be BPA-free and Gelamid® may be applied at least for portions of thestrap. All above straps may be cut of a sheet material by ultrasoniccutting.

In an example, a strap may be a single layer component such as a textileor fabric, or a composite or multiple layer components such as fabricand foam composites, or outer fabric layers and inner spacer fabrics.The straps may be made of a spandex or elastane/foam composite, or maybe formed of other suitable materials (such as a 3D spacer fabric or adouble-knit interlock fabric). These straps may be cut from a sheet ofmaterial (e.g., flame laminated), or cut from a roll of narrow fabricstrap and then thermoformed and ultrasonically welded to create roundededges before being ultrasonically welded together. The straps may have ageometry that allows them to be nested on the sheet to increase yield,e.g., the geometry may be substantially linear.

In some examples, tape may be overlaid with a thin fabric layer having athickness of about 0.1 mm and about 1 mm to maintain a desirable softsurface finish. Such thermoplastic sheets may be made from, for example:polyurethane (TPU), polyester, polyamide, polyolefin and aliphaticurethanes. These materials may be customized to provide the optimumperformance characteristics for specific applications, and may beproduced in a range of colors, opacities, and surface finishes desiredfor the end use of patient interface equipment for the treatment ofsleep disordered breathing, such as in headgear or a mask arrangement.Materials having differing degrees of flexibility may be combined in analternating manner to form a controlled flex region. Components may bestacked one on top of the other and ultrasonically welded together in amanner that leaves no space therebetween. The patient interfacecomponent may be constructed of a soft material, e.g., a soft fabric.

In an example, the thickness of the top crown strap 18 and/or lateralcrown straps 14, 17 may be at least partially about 3.8 mm (+−0.5 mm).In an example, the thickness of the neck strap 1 may be at leastpartially about 4.2 mm (+−0.5 mm). In an example, the thickness of themask connection straps 22, 24, 25, 27 may be at least partially about2.5 mm (+−0.5 mm).

In an example, at least two straps selected from the group of maskconnection straps 22, 24, 25, 27, top crown strap 18, lateral crownstraps 14, 17, and/or neck strap 1 may be connected by welding, e.g., byultrasonic welding. Exemplary welding is explained in detail in thesummary of technology in the publication WO2013/026092 A1 which isincorporated by reference. In particular, FIG. 3-1 and FIG. 3-2 ofWO2013/026092 A1 depict an example of the welding of a top crown strapand/or lateral crown straps. In an example, portions of the top crownstrap 18 and the upper mask connection straps 24, 27 may overlap andportions of the lateral crown straps 14, 17 and the upper maskconnection straps 24, 27 also may overlap. These members may be placedin an ultrasonic welding tool, e.g., such as that disclosed inWO2013/026092. An advantage of the ultrasonic welding process is that aflush or butt joint does not increase the thickness of the components atthe joint and is visually appealing, unlike stitching where componentsmust be overlapped and which results in an uneven thickness. Even if theedges of the two or more components are butted together and stitchedwithout any or substantial overlapping, the stitches will create arougher, stiffened and raised joint. Further, the ultrasonic flush orbutt joint may result in a smooth connection that may reduce skinirritation, chaffing or facial marking, even when reinforced with seamreinforcement tape. An advantage of using an overlapped ultrasonic weldvariation is that multiple components may be joined in a single machinein one operation. Furthermore, the ultrasonic welding process may bedesigned such that the joint is embodied as a thinned region or thinnedportion between the components.

5.4 PAP DEVICE 4000

A preferred PAP device 4000 in accordance with one aspect of the presenttechnology comprises mechanical and pneumatic components 4100,electrical components 4200 and is programmed to execute one or morealgorithms 4300. The PAP device preferably has an external housing 4010,preferably formed in two parts, an upper portion 4012 of the externalhousing 4010, and a lower portion 4014 of the external housing 4010. Inalternative forms, the external housing 4010 may include one or morepanel(s) 4015. Preferably the PAP device 4000 comprises a chassis 4016that supports one or more internal components of the PAP device 4000. Inone form a pneumatic block 4020 is supported by, or formed as part ofthe chassis 4016. The PAP device 4000 may include a handle 4018.

The pneumatic path of the PAP device 4000 preferably comprises an inletair filter 4112, an inlet muffler, a controllable pressure devicecapable of supplying air at positive pressure (preferably a blower4142), and an outlet muffler. One or more pressure sensors and flowsensors may be included in the pneumatic path.

The pneumatic block 4020 may comprise a portion of the pneumatic paththat is located within the external housing.

The PAP device 4000 may have an electrical power supply 4210 and one ormore input devices 4220. Electrical components 4200 may be mounted on asingle Printed Circuit Board Assembly (PCBA) 4202. In an alternativeform, the PAP device 4000 may include more than one PCBA 4202.

5.5 HUMIDIFIER 5000 5.5.1 Humidifier Overview

In one form of the present technology there is provided a humidifier5000, as shown in FIG. 3 b , that may comprise a water reservoir and aheating plate.

5.6 GLOSSARY

For the purposes of the present technology disclosure, in certain formsof the present technology, one or more of the following definitions mayapply. In other forms of the present technology, alternative definitionsmay apply.

5.6.1 General

Air: In certain forms of the present technology, air supplied to apatient may be atmospheric air, and in other forms of the presenttechnology atmospheric air may be supplemented with oxygen.

Continuous Positive Airway Pressure (CPAP): CPAP treatment will be takento mean the application of a supply of air or breathable gas to theentrance to the airways at a pressure that is continuously positive withrespect to atmosphere, and preferably approximately constant through arespiratory cycle of a patient. In some forms, the pressure at theentrance to the airways will vary by a few centimeters of water within asingle respiratory cycle, for example being higher during inhalation andlower during exhalation. In some forms, the pressure at the entrance tothe airways will be slightly higher during exhalation, and slightlylower during inhalation. In some forms, the pressure will vary betweendifferent respiratory cycles of the patient, for example being increasedin response to detection of indications of partial upper airwayobstruction, and decreased in the absence of indications of partialupper airway obstruction.

5.6.2 Aspects of PAP devices

Air circuit: A conduit or tube constructed and arranged in use todeliver a supply of air or breathable gas between a PAP device and apatient interface. In particular, the air circuit may be in fluidconnection with the outlet of the pneumatic block and the patientinterface. The air circuit may be referred to as air delivery tube. Insome cases there may be separate limbs of the circuit for inhalation andexhalation. In other cases a single limb is used.

Blower or flow generator: A device that delivers a flow of air at apressure above ambient pressure.

Controller: A device, or portion of a device that adjusts an outputbased on an input. For example one form of controller has a variablethat is under control—the control variable—that constitutes the input tothe device. The output of the device is a function of the current valueof the control variable, and a set point for the variable. Aservo-ventilator may include a controller that has ventilation as aninput, a target ventilation as the set point, and level of pressuresupport as an output. Other forms of input may be one or more of oxygensaturation (SaO₂), partial pressure of carbon dioxide (PCO₂), movement,a signal from a photoplethysmogram, and peak flow. The set point of thecontroller may be one or more of fixed, variable or learned. Forexample, the set point in a ventilator may be a long term average of themeasured ventilation of a patient. Another ventilator may have aventilation set point that changes with time. A pressure controller maybe configured to control a blower or pump to deliver air at a particularpressure.

Therapy: Therapy in the present context may be one or more of positivepressure therapy, oxygen therapy, carbon dioxide therapy, control ofdead space, and the administration of a drug.

Positive Airway Pressure (PAP) device: A device for providing a supplyof air at positive pressure to the airways.

5.6.3 Anatomy of the face

Ala: the external outer wall or “wing” of each nostril (plural: alar)

Alare: The most lateral point on the nasal ala.

Alar curvature (or alar crest) point: The most posterior point in thecurved base line of each ala, found in the crease formed by the union ofthe ala with the cheek.

Auricula or Pinna: The whole external visible part of the ear.

(nose) Bony framework: The bony framework of the nose comprises thenasal bones, the frontal process of the maxillae and the nasal part ofthe frontal bone.

(nose) Cartilaginous framework: The cartilaginous framework of the nosecomprises the septal, lateral, major and minor cartilages.

Columella: the strip of skin that separates the nares and which runsfrom the pronasale to the upper lip.

Columella angle: The angle between the line drawn through the midpointof the nostril aperture and a line drawn perpendicular to the Frankfurthorizontal while intersecting subnasale.

Frankfort horizontal plane: A line extending from the most inferiorpoint of the orbital margin to the left tragion. The tragion is thedeepest point in the notch superior to the tragus of the auricle.

Glabella: Located on the soft tissue, the most prominent point in themidsagittal plane of the forehead.

Lateral nasal cartilage: A generally triangular plate of cartilage. Itssuperior margin is attached to the nasal bone and frontal process of themaxilla, and its inferior margin is connected to the greater alarcartilage.

Lip, lower (labrale inferius):

Lip, upper (labrale superius):

Greater alar cartilage: A plate of cartilage lying below the lateralnasal cartilage. It is curved around the anterior part of the naris. Itsposterior end is connected to the frontal process of the maxilla by atough fibrous membrane containing three or four minor cartilages of theala.

Nares (Nostrils): Approximately ellipsoidal apertures forming theentrance to the nasal cavity. The singular form of nares is naris(nostril). The nares are separated by the nasal septum.

Naso-labial sulcus or Naso-labial fold: The skin fold or groove thatruns from each side of the nose to the corners of the mouth, separatingthe cheeks from the upper lip.

Naso-labial angle: The angle between the columella and the upper lip,while intersecting subnasale.

Otobasion inferior: The lowest point of attachment of the auricle to theskin of the face.

Otobasion superior: The highest point of attachment of the auricle tothe skin of the face.

Pronasale: the most protruded point or tip of the nose, which can beidentified in lateral view of the rest of the portion of the head.

Philtrum: the midline groove that runs from lower border of the nasalseptum to the top of the lip in the upper lip region.

Pogonion: Located on the soft tissue, the most anterior midpoint of thechin.

Ridge (nasal): The nasal ridge is the midline prominence of the nose,extending from the Sellion to the Pronasale.

Sagittal plane: A vertical plane that passes from anterior (front) toposterior (rear) dividing the body into right and left halves.

Sellion: Located on the soft tissue, the most concave point overlyingthe area of the frontonasal suture.

Septal cartilage (nasal): The nasal septal cartilage forms part of theseptum and divides the front part of the nasal cavity.

Subalare: The point at the lower margin of the alar base, where the alarbase joins with the skin of the superior (upper) lip.

Subnasal point: Located on the soft tissue, the point at which thecolumella merges with the upper lip in the midsagittal plane.

Supramentale: The point of greatest concavity in the midline of thelower lip between labrale inferius and soft tissue pogonion

5.6.4 Anatomy of the Skull

Frontal bone: The frontal bone includes a large vertical portion, theSquama frontalis, corresponding to the region known as the forehead.

Mandible: The mandible forms the lower jaw. The mental protuberance isthe bony protuberance of the jaw that forms the chin.

Maxilla: The maxilla forms the upper jaw and is located above themandible and below the orbits. The frontal process of the maxillaprojects upwards by the side of the nose, and forms part of its lateralboundary.

Nasal bones: The nasal bones are two small oblong bones, varying in sizeand form in different individuals; they are placed side by side at themiddle and upper part of the face, and form, by their junction, the“bridge” of the nose.

Nasion: The intersection of the frontal bone and the two nasal bones, adepressed area directly between the eyes and superior to the bridge ofthe nose.

Occipital bone: The occipital bone is situated at the back and lowerpart of the cranium. It includes an oval aperture, the foramen magnum,through which the cranial cavity communicates with the vertebral canal.The curved plate behind the foramen magnum is the Squama occipitalis.

Orbit: The bony cavity in the skull to contain the eyeball.

Parietal bones: The parietal bones are the bones that, when joinedtogether, form the roof and sides of the cranium.

Temporal bones: The temporal bones are situated on the bases and sidesof the skull, and support that part of the face known as the temple.

Zygomatic bones: The face includes two zygomatic bones, located in theupper and lateral parts of the face and forming the prominence of thecheek.

5.6.5 Anatomy of the Respiratory System

Diaphragm: A sheet of muscle that extends across the bottom of the ribcage. The diaphragm separates the thoracic cavity, containing the heart,lungs and ribs, from the abdominal cavity. As the diaphragm contractsthe volume of the thoracic cavity increases and air is drawn into thelungs.

Larynx: The larynx, or voice box houses the vocal folds and connects theinferior part of the pharynx (hypopharynx) with the trachea.

Lungs: The organs of respiration in humans. The conducting zone of thelungs contains the trachea, the bronchi, the bronchioles, and theterminal bronchioles. The respiratory zone contains the respiratorybronchioles, the alveolar ducts, and the alveoli.

Nasal cavity: The nasal cavity (or nasal fossa) is a large air filledspace above and behind the nose in the middle of the face. The nasalcavity is divided in two by a vertical fin called the nasal septum. Onthe sides of the nasal cavity are three horizontal outgrowths callednasal conchae (singular “concha”) or turbinates. To the front of thenasal cavity is the nose, while the back blends, via the choanae, intothe nasopharynx.

Pharynx: The part of the throat situated immediately inferior to (below)the nasal cavity, and superior to the oesophagus and larynx. The pharynxis conventionally divided into three sections: the nasopharynx(epipharynx) (the nasal part of the pharynx), the oropharynx(mesopharynx) (the oral part of the pharynx), and the laryngopharynx(hypopharynx).

5.6.6 Materials

Silicone or Silicone Elastomer: A synthetic rubber. In thisspecification, a reference to silicone is a reference to liquid siliconerubber (LSR) or a compression moulded silicone rubber (CMSR). One formof commercially available LSR is SILASTIC (included in the range ofproducts sold under this trademark), manufactured by Dow Corning.Another manufacturer of LSR is Wacker. Unless otherwise specified to thecontrary, a preferred form of LSR has a Shore A (or Type A) indentationhardness in the range of about 35 to about 45 as measured using ASTMD2240.

Polycarbonate: a typically transparent thermoplastic polymer ofBisphenol-A Carbonate.

5.6.7 Aspects of a Patient Interface

Anti-asphyxia valve (AAV): The component or sub-assembly of a masksystem that, by opening to atmosphere in a failsafe manner, reduces therisk of excessive CO₂ rebreathing by a patient.

Elbow: A conduit that directs an axis of flow of air to change directionthrough an angle. In one form, the angle may be approximately 90degrees. In another form, the angle may be less than 90 degrees. Theconduit may have an approximately circular cross-section. In anotherform the conduit may have an oval or rectangular cross-section.

Frame: Frame will be taken to mean a mask structure that bears the loadof tension between two or more points of connection with a headgear. Amask frame may be a non-airtight load bearing structure in the mask.However, some forms of mask frame may also be air-tight.

Functional dead space: The functional dead space refers to at least oneregion within a breathing circuit where a patient's exhalate may collectsuch that the normal flow of gas within the breathing circuit cannoteffectively flush the exhalate from the breathing circuit.

Headgear: Headgear will be taken to mean a form of positioning andstabilizing structure designed for use on a head. Preferably theheadgear comprises a collection of one or more struts, ties andstiffeners configured to locate and retain a patient interface inposition on a patient's face for delivery of respiratory therapy. Someties are formed of a soft, flexible, elastic material such as alaminated composite of foam and fabric.

Membrane: Membrane will be taken to mean a typically thin element thathas, preferably, substantially no resistance to bending, but hasresistance to being stretched.

Plenum chamber: a mask plenum chamber will be taken to a mean portion ofa patient interface having walls enclosing a volume of space, the volumehaving air therein pressurised above atmospheric pressure in use. Ashell may form part of the walls of a mask plenum chamber. In one form,a region of the patient's face forms one of the walls of the plenumchamber.

Seal: The noun form (“a seal”) will be taken to mean a structure orbarrier that intentionally resists the flow of air through the interfaceof two surfaces. The verb form (“to seal”) will be taken to mean toresist a flow of air.

Shell: A shell will preferably be taken to mean a curved structurehaving bending, tensile and compressive stiffness, for example, aportion of a mask that forms a curved structural wall of the mask.Preferably, compared to its overall dimensions it is relatively thin. Insome forms, a shell may be faceted. Preferably such walls are airtight,although in some forms they may not be airtight.

Stiffener: A stiffener will be taken to mean a structural componentdesigned to increase the bending resistance of another component in atleast one direction.

Strut: A strut will be taken to be a structural component designed toincrease the compression resistance of another component in at least onedirection.

Swivel: (noun) A subassembly of components configured to rotate about acommon axis, preferably independently, preferably under low torque. Inone form, the swivel may be constructed to rotate through an angle of atleast 360 degrees. In another form, the swivel may be constructed torotate through an angle less than 360 degrees. When used in the contextof an air delivery conduit, the sub-assembly of components preferablycomprises a matched pair of cylindrical conduits. Preferably there islittle or no leak flow of air from the swivel in use.

Tie: A tie will be taken to be a structural component designed to resisttension.

Vent: (noun) the structure that allows a deliberate controlled rate leakof air from an interior of the mask, or conduit to ambient air, to allowwashout of exhaled carbon dioxide (CO₂) and supply of oxygen (O₂).

5.6.8 Terms Used in Relation to Patient Interface

Curvature (of a surface): A region of a surface having a saddle shape,which curves up in one direction and curves down in a differentdirection, will be said to have a negative curvature. A region of asurface having a dome shape, which curves the same way in two principledirections, will be said to have a positive curvature. A flat surfacewill be taken to have zero curvature.

Floppy: A quality of a material, structure or composite that is thecombination of features of:

-   -   Readily conforming to finger pressure.    -   Unable to retain its shape when caused to support its own        weight.    -   Not rigid.    -   Able to be stretched or bent elastically with little effort.

The quality of being floppy may have an associated direction, hence aparticular material, structure or composite may be floppy in a firstdirection, but stiff or rigid in a second direction, for example asecond direction that is orthogonal to the first direction.

Resilient: Able to deform substantially elastically, and to releasesubstantially all of the energy upon unloading, within a relativelyshort period of time such as 1 second.

Rigid: Not readily deforming to finger pressure, and/or the tensions orloads typically encountered when setting up and maintaining a patientinterface in sealing relationship with an entrance to a patient'sairways.

Semi-rigid: means being sufficiently rigid to not substantially distortunder the effects of mechanical forces typically applied during positiveairway pressure therapy.

5.7 OTHER REMARKS

A portion of the disclosure of this patent document contains materialwhich is subject to copyright protection. The copyright owner has noobjection to the facsimile reproduction by anyone of the patent documentor the patent disclosure, as it appears in the Patent and TrademarkOffice patent file or records, but otherwise reserves all copyrightrights whatsoever.

Unless the context clearly dictates otherwise and where a range ofvalues is provided, it is understood that each intervening value, to thetenth of the unit of the lower limit, between the upper and lower limitof that range, and any other stated or intervening value in that statedrange is encompassed within the technology. The upper and lower limitsof these intervening ranges, which may be independently included in theintervening ranges, are also encompassed within the technology, subjectto any specifically excluded limit in the stated range. Where the statedrange includes one or both of the limits, ranges excluding either orboth of those included limits are also included in the technology.

Furthermore, where a value or values are stated herein as beingimplemented as part of the technology, it is understood that such valuesmay be approximated, unless otherwise stated, and such values may beutilized to any suitable significant digit to the extent that apractical technical implementation may permit or require it.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this technology belongs. Although any methods andmaterials similar or equivalent to those described herein can also beused in the practice or testing of the present technology, a limitednumber of the exemplary methods and materials are described herein.

When a particular material is identified as being preferably used toconstruct a component, obvious alternative materials with similarproperties may be used as a substitute. Furthermore, unless specified tothe contrary, any and all components herein described are understood tobe capable of being manufactured and, as such, may be manufacturedtogether or separately.

It must be noted that as used herein and in the appended claims, thesingular forms “a”, “an”, and “the” include their plural equivalents,unless the context clearly dictates otherwise.

All publications mentioned herein are incorporated by reference todisclose and describe the methods and/or materials which are the subjectof those publications. The publications discussed herein are providedsolely for their disclosure prior to the filing date of the presentapplication. Nothing herein is to be construed as an admission that thepresent technology is not entitled to antedate such publication byvirtue of prior invention. Further, the dates of publication providedmay be different from the actual publication dates, which may need to beindependently confirmed.

Moreover, in interpreting the disclosure, all terms should beinterpreted in the broadest reasonable manner consistent with thecontext. In particular, the terms “comprises” and “comprising” should beinterpreted as referring to elements, components, or steps in anon-exclusive manner, indicating that the referenced elements,components, or steps may be present, or utilized, or combined with otherelements, components, or steps that are not expressly referenced.

The subject headings used in the detailed description are included onlyfor the ease of reference of the reader and should not be used to limitthe subject matter found throughout the disclosure or the claims. Thesubject headings should not be used in construing the scope of theclaims or the claim limitations.

Although the technology herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thetechnology. In some instances, the terminology and symbols may implyspecific details that are not required to practice the technology. Forexample, although the terms “first” and “second” may be used, unlessotherwise specified, they are not intended to indicate any order but maybe utilised to distinguish between distinct elements. Furthermore,although process steps in the methodologies may be described orillustrated in an order, such an ordering is not required. Those skilledin the art will recognize that such ordering may be modified and/oraspects thereof may be conducted concurrently or even synchronously.

It is therefore to be understood that numerous modifications may be madeto the illustrative embodiments and that other arrangements may bedevised without departing from the spirit and scope of the technology.

While the present technology has been described in connection with whatare presently considered to be the most practical and preferredexamples, it is to be understood that the technology is not to belimited to the disclosed examples, but on the contrary, is intended tocover various modifications and equivalent arrangements included withinthe spirit and scope of the technology. Also, the various examplesdescribed above may be implemented in conjunction with other examples,e.g., aspects of one example may be combined with aspects of anotherexample to realize yet other examples. Further, each independent featureor component of any given assembly may constitute an additional example.

5.8 REFERENCE SIGNS LIST Number Feature Item

-   -   1 neck strap    -   2 first lower connection portion    -   2′ first lower connection edge portion    -   3 major side edge    -   4 first upper connection portion    -   4′ first upper connection edge portion    -   5 second lower connection portion    -   5′ second lower connection edge portion    -   6 major side edge    -   7 second upper connection portion    -   7′ second upper connection edge portion    -   8 first transitional edge portion    -   9 second transitional edge portion    -   10 headgear    -   12 first minor side edge    -   13 second minor side edge    -   14 lateral crown strap    -   14 a connection portion    -   15 crown assembly    -   17 lateral crown strap    -   17 a connection portion    -   18 top crown strap    -   18 a connection portion    -   19 stepped front side    -   22 lower mask connection strap    -   24 upper mask connection strap    -   25 lower mask connection strap    -   27 upper mask connection strap    -   30 fastener member    -   32 stepped front side    -   34 smooth front side    -   100 headgear    -   102 lateral crown section    -   102 a end portion    -   104 lateral crown section    -   104 a end portion    -   106 upper crown section    -   108 upper mask connection strap    -   110 lower mask connection strap    -   115 joint    -   1000 patient    -   1100 bed partner    -   3000 patient interface    -   3100 seal-forming structure    -   3200 plenum chamber    -   3300 positioning and stabilising structure    -   3400 vent    -   3500 decoupling structure    -   3600 connection port    -   3700 forehead support    -   4000 PAP device    -   4010 housing    -   4012 upper portion    -   4014 lower portion    -   4015 panels    -   4016 chassis    -   4018 handle    -   4020 pneumatic block    -   4100 mechanical and pneumatic components    -   4112 filter    -   4142 blower    -   4170 gas delivery tube/air circuit    -   4180 gas delivery tube    -   4190 adaptor    -   4200 electrical components    -   4202 PCBA    -   4210 power supply    -   4220 input devices    -   4300 algorithms    -   5000 humidifier

1. Neck strap for a headgear, comprising: a one-piece main body adaptedto engage a patient's neck, the main body including: first and secondlower connection portions adapted to connect to respective first andsecond lower mask connection straps, and first and second upperconnection portions adapted to connect to respective first and secondlateral crown straps.
 2. Neck strap according to claim 1, wherein theneck strap is substantially flat.
 3. Neck strap according to claim 1,wherein the main body comprises two opposing major side edges.
 4. Neckstrap according to claim 3, wherein the at least one of the opposingmajor side edges comprises a curved portion.
 5. Neck strap according toclaim 4, wherein the curved portion is concave.
 6. Neck strap accordingto claim 4, wherein the two opposing major side edges include a curvedportion and wherein the neck strap has at least partially a reducedwidth between the two opposing major side edges in the curved portion.7. Neck strap according to claim 3, wherein the main body comprises twoopposing minor side edges, wherein the opposing major side edgesinterconnect the opposing minor side edges.
 8. Neck strap according toclaim 7, wherein the first lower connection portion and/or the firstupper connection portion is/are located at a first of the two opposingminor side edges, and/or wherein the second lower connection portionand/or the second upper connection portion is/are located at a second ofthe two opposing minor side edges.
 9. Neck strap according to claim 8,wherein the first and/or second lower connection portion extendssubstantially parallel to an adjacent portion of the respective minorside edge, and/or wherein the first and/or second upper connectionportion extends substantially parallel to an adjacent portion of therespective minor side edge.
 10. Neck strap according to claim 8, whereinthe first and/or second lower connection portion and/or respectiveportions of the minor side edges is/are oriented substantiallyperpendicular to a main axis of extension of the respective first and/orsecond lower mask connection strap.
 11. Neck strap according to claim 8,wherein the first and second upper connection portions and/or theadjacent portions of the minor side edges are oriented in an acute angleto a main axis of extension of the respective first and second lateralcrown straps.
 12. Neck strap according to claim 8, wherein respectivefirst and second transitional edge portions are connected tangentiallywith the respective portions of the minor side edges adjacent to therespective first and second upper connection portions.
 13. Neck strapaccording to claim 8, wherein respective first and second transitionaledge portions intersects with the respective portions of the minor sideedges adjacent to the respective first and second lower connectionportions in an angle between about 60° to 120°.
 14. Neck strap accordingto claim 13, wherein the angle is between about 75° to 105°.
 15. Neckstrap according to claim 13, wherein the angle is about 90°.
 16. Neckstrap according to claim 1, wherein the neck strap is symmetrical to afirst axis, wherein the first axis in an application position issubstantially parallel to the sagittal plane of a user.
 17. Neck strapaccording to claim 16, wherein the neck strap includes a second axisthat extends perpendicular to the first axis.
 18. Neck strap accordingto claim 17, wherein a width perpendicular to the second axis of theneck strap is lowest between a curved portion of two opposing major sideedges of the main body.
 19. Neck strap according to claim 17, wherein awidth perpendicular to the second axis of the neck strap is highest at across-section in which a major side edge intersects with a minor sideedge.
 20. Neck strap according to claim 7, wherein the major side edgesand/or the minor side edges are rounded.